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Michigan rates for HCPCS 99242

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $68 · 10th–90th $51–$810%20%10th90th$68Professionalmedian $81 · 10th–90th $48–$1480%5%10%10th90th$81$5.0$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $60.26 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $79.43 / $147.91
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $144.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $81.28
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $91.20
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $69.18 / $93.33
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $91.20 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $85.11 / $141.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $81.28 / $100.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $81.28 / $144.54
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $83.18 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $77.62 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $134.90